Acute pancreatitis is as painful as it sounds and it’s important to determine the cause before embarking on dietary changes.
Question: I have experienced repeated attacks of pancreatitis, which baffled doctors because I do not drink alcohol and removing my gallbladder did not stop the attacks. I was advised to follow a low-fat, dairy-free and egg-free diet. However, local cafes rarely have anything I can eat in the cabinet. Do you have any suggestions on managing my diet while eating out?
Answer: The pancreas, a small but crucial organ located behind the stomach and below the ribcage, is a key player in our digestive system. Although it may not receive as much attention as the stomach and intestines, it is responsible for vital digestive processes. Pancreatitis can disrupt these processes. The incidence of pancreatitis has been on the rise in Western countries, increasing by 3% annually over the past 50 years, noted a 2022 review in Gastroenterology.
Usually, the pancreas releases enzymes (or digestive juices) into your small intestine to break down food after it leaves your stomach. These enzymes break down proteins, fats and carbohydrates. The pancreas also secretes insulin, a hormone, into your bloodstream to regulate glucose levels.
When acute pancreatitis strikes, the pancreas becomes swollen or inflamed, and in severe cases, it can sustain damage. The primary symptom of acute pancreatitis is intense pain in the upper or middle part of the abdomen, just below the ribs. This pain can radiate to the back or left shoulder blade. Other symptoms may include nausea, vomiting, fever, a swollen abdomen and diarrhoea. It’s crucial to seek medical advice promptly to ensure a correct diagnosis and appropriate treatment.
Acute pancreatitis is usually linked to gallstones and heavy alcohol use. However, other risk factors have been associated with it and may account for the growing incidence in Western countries. These include an ageing population, metabolic syndrome and the use of medications such as statins, type 2 diabetes treatments and oestrogen-containing therapies, the 2022 review found.
Registered dietitian Kylie Russell, who specialises in nutritional support for pancreatic disease, advises, “If you’re unclear what’s causing your pancreatitis, I recommend seeking a review by a specialist pancreatic surgeon to rule out all known causes. These specialists are often located in the main cities. Sometimes, a cause isn’t found, which is very frustrating for everyone.”
Russell recommends abstaining from alcohol for life if alcohol was the cause of your pancreatitis – “alcohol is a known trigger”. Given you don’t drink alcohol and have had your gallbladder removed, those are not precipitating factors. However, it is unclear in your email whether your doctors have determined any other potential causes for your recurrent episodes.”
Regarding nutritional support, an egg-free, dairy-free, low-fat diet is very restrictive. “I’ve never come across an egg-free, dairy-free diet specifically for pancreatitis,” says Russell. “The low-fat diet recommendation has been around for a while, but there’s not much strong evidence to back it up.”
Traditionally, low-fat diets were recommended based on the theory that they rested the pancreas and reduced symptoms while promoting healing. But avoiding dietary fat does not “rest” the pancreas.
“Patients with a mild pancreatitis episode often stop eating,” she says. “Once they start feeling better, they usually start with a low-fat or light diet because that’s what most people feel like and can tolerate. But there’s no need to stick to a strict low-fat diet in the long run.”
Remaining on a low-fat diet long term will limit your intake of essential nutrients from important food groups.
While diet may play a role in developing acute pancreatitis, there is no clear proof it causes it directly, though “eating a high-fat diet for a long time, along with drinking alcohol and having gallstones, can increase your risk,” says Russell.
Rather than avoiding all dairy products and eggs while following a low-fat diet long term, she recommends eating a normal, varied and balanced diet with fat in moderation and avoiding alcohol, while seeking further expert opinion to determine the cause of your recurrent episodes.
